When my brother, Arnold, was diagnosed with ADHD and depression, it came as a complete shock and redefined my perspective on what it meant to have a mental health condition, especially since we’re Korean. Being raised in a Korean household, upholding a good reputation is a core value. My father has always instilled the importance of chae-myoun, a Korean concept that drives all behavior and thinking.
Part of this concept stipulates that to ensure a good reputation for ourselves and the family, disclosing any type of emotional distress or mental health condition is forbidden because it is a sign of weakness. Due to this upbringing, I had the paradigm that all mental health disorders are a condition that could be easily overcome through self-discipline and willpower. In the Korean culture, chae-myoun in its literal translation means ‘face’ however, the metaphorical definition can be defined as “the appearance of self-worth that is shown to others.”
Because our culture highly values the perception of others, children are taught from an early age the importance of academic and professional success. It is deeply ingrained that an individual’s ability to be accepted into one of the most prestigious universities and to secure a high paying job heavily influences their social status and their chae-myoun. Having a good reputation or a ‘good face’ is not only a reflection on the individual, but on their family as well. There is a strong belief that a parent’s ability to discipline, and instill hard work and ethics is a major contributor to a child’s success. This is why, when a person receives a prestigious award, the parents are often congratulated in addition to the recipient.
Due to this one-dimensional focus on the definition of success, it causes a competitive attitude amongst children and parents. Children are constantly taught to perform at their best and to ensure that their reputation isn’t outshined by a peer. As a result, the term “mental health” doesn’t really exist in the culture. Showing signs of emotional distress or having a mental health condition, such as depression is perceived as being ‘weak’ or ‘crazy’. If a person is known to have a mental health disorder, parents will often hide this fact from family and friends, for fear of being criticized of their parenting skills.
My brother was 25 years old when he was first diagnosed with ADHD and depression. Explaining these mental disorders to my father came with multiple challenges. To start, we could not find a direct translation for ‘Attention Deficit Hyperactivity Disorder’ in Korean. Although there was partial blame to language barriers, ADHD remains as a relatively new mental disorder to Koreans (“ADHD” in the Korean dictionary appears as a romanization of the English term instead of an actual definition). When we did finally discover a translation, my father was in complete denial.
He could not understand how Arnold had developed these mental disorders when I didn’t–after all we were raised in the same household under the same disciplinary structure. The only explanation my father could think of, was that these diagnoses were an excuse for his indolent behavior. Secondly, my father couldn’t see past the stigma. He was extremely concerned on how others would perceive our family’s reputation and as a result, he immediately forced my brother to quit treatment, when it was discovered that he was receiving medication for his symptoms.
I initially agreed with my father, that there were never any apparent “signs” of Arnold having ADHD and depression. He always received satisfactory grades in high school and he seemed to have a lot of friends throughout that time. Arnold was even the first person to attend college in my family and did it on a full scholarship. He had a long-term girlfriend that he was set on marrying and had a close group of friends that he would frequently meet with. If there were any problems that I could identify, I truly felt as though his computer addiction was to blame (Arnold was later diagnosed with an “addiction” but it was not known at this time).
Growing up, I had a lot of memories of Arnold playing video games on his computer. He had a pattern for procrastinating and ignoring his responsibilities because of this. He would rarely complete his chores, homework, and would even go days without communicating with us. I would see a majority of his time being awake at night and sleeping throughout the day. To me, I strongly felt like the symptoms that were listed for ADHD and depression were side effects of his excessive computer use. Clearly I made an assumption at the time thinking the diagnoses were really indeed an excuse to explain his lack of his accountability.
After Arnold’s first year of college, my father and I noticed that his time spent on video games began to increase. Arnold would stay in his room for nearly the entire day and would not leave unless it was strictly for food or the bathroom. As time progressed, he eventually stopped seeing his friends, and his girlfriend would spend more time with us at our home. Seven years after he told us about his diagnosis, his life seemed like it had taken a downward spiral. It took him nearly a decade to complete his college degree and it was impossible for him to hold a job longer than a few months.
He would continuously spend time on his computer and would ignore his work shifts. Not long after his graduation, his fiancée broke off their engagement after ten years. She had expressed her frustrations with Arnold’s inability to improve his life and felt as though he was using ADHD and depression as an excuse from partaking in any kind of activity outside his room. Despite the repercussions he faced, he continued to stay on the computer. Eventually, I had a lot of anger and resentment had built towards my brother. It was extremely frustrating to look past the image of a thirty-year-old being financially dependent on a parent.
This often led to having heated arguments that would end with me saying a hurtful comment, and a response from him, “do you think I enjoy living like this? I wish my life wasn’t this way, but I don’t know what else to do.” Whenever I would hear this response, it was difficult for me to comprehend his point of view. To me, the answer seemed so simple. If he didn’t like the way his current situation was, he could always make the effort to change. If he truly felt depressed and lonely, he could always outreach to the people around him.
My perception and paradigm of mental disorders and illnesses were thought to be of a conscious choice. I strongly felt that individuals such as my brother, were choosing to stay in the same condition for a variety of reasons such as, a fear of change, being too comfortable, not knowing how to make changes, etc. Being raised in a culture where mental disorders were thought to be a sign of weakness, I couldn’t help but to think that people who suffered from these conditions, lacked self-discipline and self-control. I believed that patients who took medication for mental health conditions were further harming themselves because I felt like it was used as a crutch rather than fixing the root of the issue.
Then, last year, I took a course called “Treatment of Chemical Dependency”. I honestly took the course because I wanted to learn more about the application of social work strategies in working with individuals and families who have addictions. I figured there would be some information that could be applicable to my current life. Throughout this class, we learned about different types of addictions and how they occur in our brain. I learned that our reward pathways are stimulated by certain behaviors such as drug use or sex. When an individual ingests a drug, the body sends exaggerated signals to the prefrontal cortex.
The signal will then seize the prefrontal cortex into thinking that it is a fulfilled instinctual drive and it should be repeated. I also learned about deficiencies in certain chemicals in our brain that cause individuals to have depression or ADHD. People with depression are known to have little serotonin within the limbic system. There were even several cases that our class discussed regarding the misdiagnosis of ADHD and how it can lead to depression.
At the end of that semester, when the class was finally over, I realized that I had a paradigm shift. I felt like I had a deeper understanding of what it meant to have a mental health disorder and to empathize with those who live with a mental health condition. It was exceptionally important for me to recognize that conditions such as depression were not the result of having a weak mind or a lack of self-discipline.
It completely changed my perspective on the responsibilities of a social worker and how I viewed my clients. It allowed me to see my clients with more respect and it provided empowerment for, not just myself, but the client that I will be working with. Recognizing that certain moods or decisions are caused by involuntary chemical changes, made me see that illnesses such as addiction are a lifelong illness and that as a social worker, it is important to know that individuals will face these hardships even when I stop seeing them.
This paradigm shift helped me realize my error in how I treated my brother. I realized that mental health disorders are not any different from a physical illness or condition. Therefore, individuals should be encouraged to take medication and see a therapist if it is beneficial. As my professor had once said, “if people can take medication to help their diabetes without the judgment of others, why can’t people take medication for their mental health?” To go back and remember that my brother was forced to quit treatment sounds completely inhumane.
It was a terrifying moment to realize that my previous paradigm had masked the ethics of what I thought was a great decision. I could not be more apologetic to my brother today. I often wonder how different his life would’ve been, if we had encouraged him to seek help earlier. I also reflect on what Arnold used to say to me at the end of every argument. “Do you think I enjoy living like this? I wish my life wasn’t this way, but I don’t know what else to do.” Thinking about this statement and applying the information that I learned from my class, helped me see the inaccurate assumptions and judgments I made off of him.
This paradigm shift also helped me recognize that certain cultural aspects don’t have to be followed. Living in America, I was brought up to have two types of perspectives, one American and one Korean. Having a bicultural identity often comes with conflict and there is a challenge in balancing the influences between two cultures. After I experienced this shift, I am now more aware of how culture defines me and the way I define myself. I now view my perspectives through a second conscience and truly ask myself questions before I make an assumption.